A Joint Report by the Psychiatric Nurses Association (PNA) and the Royal College of Surgeons of Ireland (RCSI) of the Vision for Change (2006) mental health strategy ten years on from its introduction, shows that services have been reduced without the proper replacement for them being put in place and numbers of staff have been reduced despite a growing demand for mental health services.
Speaking at the launch today (Tuesday, June 21 st ) of the final report of a Joint PNA/RCSI study to mark the 10 th anniversary of the introduction of the Government's ‘ Vision for Change' strategy for the mental health services, PNA General Secretary , Des Kavanagh said despite the hopes for the transformation of services under ‘Vision for Change' it is clear now that successive governments have seen the implementation of ‘Vision' as a means of cutting investment and removing services without putting in place the planned replacement for them.
‘Crucial elements of the VFC strategy to transform our mental health services have not been implemented particularly in the areas of community care and crisis intervention.'
‘This report confirms that while we have seen a welcome move from institutional care the investment of staff and resources in the build-up of fully staffed community based multi-disciplinary mental health services as the main method of treatment delivery remains a mere aspiration across most of the country.'
Mr Kavanagh said the PNA/RCSI demonstrates starkly that despite the aspirations set out in the VFC strategy ten years ago it has not been translated into reality.
The Report concludes:
The evidence reported indicates that what was identified as best practice in terms of mental health service development and provision has not been implemented in any significant, meaningful or cohesive way. The findings indicate that there has been a significant failure to implement national policy; the findings clearly indicate that this failure has very significant impact on the quality of mental health service and care available to the Irish public.
Des Kavanagh said the PNA/RCSI Study had identified three priorities to overcome the barriers to the successful implementation of VFC.
• comprehensive staffing and resourcing of community-based services
• increased crisis intervention / outreach services
• local services to be underpinned and cohered through the development of a shared IT infrastructure.
Des Kavanagh said: ‘It is very significant that on the tenth year anniversary of Vision for Change the PNA is on the brink of a national campaign of industrial action in protest at the chronic understaffing of services across the country. While this understaffing impacts on all levels of services one of the impacts of it has been the continual diversion of staff from community to acute services to fill staffing shortages. This is further evidence of the lack of commitment to community mental health services as envisaged in Vision for Change.
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The Report finds :
• The study found that, in a number of areas in the community-based mental health services, the recommendations put forth in A Vision for Change (2006) have been poorly implemented, or indeed, not implemented at all, leading to many gaps in service provision.
• The study found that the failure of the national mental health system to translate the principles of recovery into meaningful practice stemmed from its failure to provide key resources vital to the full implementation of A Vision for Change (2006). Severe staff shortages emerged as the most striking deficiency in the functioning of the mental health services, impacting on all levels of service provision.
• The study found that, while A Vision for Change (2006) recommended that the closure of traditional mental health institutions be accompanied by the provision of services in the community to which patients may be transferred, the failure to adequately resource the community-based infrastructure has led to a deficit in patient-appropriate options.
• This failure has led to a blockage of beds in acute units and hostels and the placing of patients almost to wherever there is a bed rather than to a unit that best serves their particular needs.
• The report identifies deficits in specialist, outreach and crises service provision stemming from the failure to adequately resource the community-based infrastructure, as well as inequalities in service provision within and between regions, and discusses the impact of these systemic shortfalls on patients, families and communities.
• The report identifies successes in meeting some of the recommendation of A Vision for Change (2006) have been achieved, with Cavan Monaghan, South Tipperary and East Dublin regions reaching a high standard of care in some of their community-based services and concluding that availability of services and standards of provision vary greatly within and across the twenty-six counties.
PNA / RCSI High Level Survey Findings.
Method : This mixed methods descriptive study set out to establish a national compositional and contextual baseline insofar as possible and to investigate and examine the evaluation by members (Branch Officers) of the PNA of the impact of VFC on the reality of service provision in terms of adult mental health services within their own area.
High level findings include :
• 67% of respondents indicated that they do not have a fully staffed community based multi-disciplinary rehabilitation and recovery mental health service.
• Over 2 out of 3 respondents indicated that there has been no multi-professional manpower plan linked to projected service planning put in place within the catchment area
• 3 out of every 4 respondents (75%) indicated that within their services they do not have fully staffed community based multi-disciplinary mental health services to ensure home based treatment is the main method of treatment delivery.
• Just 38% of respondents indicated that they have a fully staffed community based mental health teams within their adult mental health service.
• 66% do not work within a well-trained, fully staffed community based multidisciplinary community mental health team.
• While 78% of respondents have access to in-patient admission facilities, 45% did not have access to 50 beds per catchment area. ( The challenge reported nationally is access due to occupancy of over 100% within the acute in-patient units, delayed discharges which are primarily attributed to a lack of alternative community based facilities, a lack of rehabilitation beds, a lack of availability of crises or step down beds and a lack of regional ICRU services.)
• 70% said services have not been evaluated with meaningful performance indicators annually to assess the added value the service is contributing to the mental health of the local catchment area population
Crisis Intervention/Outreach Services:
The most significant service deficiencies are the lack of crises services, assertive outreach and ICRU services.
• 74% of respondents do not have access to a crises house service based on the VFC framework.
• 79% said that their service did not have an Assertive Outreach Team based on the VFC framework.
• A further 40% indicated a lack of access to residential units within the recovery and rehabilitation service.
• 73% of respondents report that their services do not have access to regional ICRU beds
Respondents identified the following VFC priorities that have not been achieved
• A lack of High Observation beds/ICRU
• A lack of crises services
• A lack of assertive outreach
• Incomplete (not fully staffed) CMH teams
• A lack of specialist services (addictions, eating disorders
• Lack of home based treatment teams
• Community services offered on a 9-5 Monday to Friday basis.
• No dual diagnosis service (Psyc/ ID)
• Limited EIS
• Inconsistent service development nationally
• Access to day centres and day hospitals limited